perinatal mental health care in switzerland

Conditions: Mental Disorder; Perinatal; Depression; Anxiety Disorders; Panic Disorder; Post Traumatic Stress Disorder; Adaptation Reaction; Behavior Disorders; Substance Abuse; Psychosis; Health Care Seeking Behavior; Health Care Utilization; Health Care Acceptability

Summary: this qualitative study with quantitative elements examines the health care provided to women who suffered from mental disorder during pregnancy and / or in the first year after birth (i.e. during the perinatal phase). investigators will perform individual interviews with former pmd patients, and health and social care professionals to gain insights into current health care for pmd patients.

background: perinatal mental disorders (pmd) are highly prevalent (up to 20%), and patients use mental health care at high rates (berger et al 2018). it is not known if the health care for pmd patients meets the needs of the patients. aim: the investigators will identify factors that promote or hinder service provision and access to care, for a range of relevant pmd. the investigation will cover the user and provider perspectives. methods: the qualitative study consists of two complementary parts to assess user and provider perspectives. in part 1 the investigators will conduct individual semi-structured interviews with 24 women who have had pmd. the sample will comprise of 4 clusters of relevant icd-10 f-diagnoses, covering a wide range of mental disorders. the sample will also comprise of participants who received or did not receive mental health care before the last pregnancy. in part 2, the investigators perform 3 focus groups (with 6-8 participants per group) with health and social care professionals, and a health-insurance delegate, to collect their experiences and perspectives on perinatal health care for pmd patients. the investigators are guided for data collection and analysis by levesque's et al (2013) conceptual model on access to health care. expected results: the study will identify barriers and facilitators for health care access (user perspective) and provision (provider perspective). the study will generate the evidence base needed to develop integrated, coordinated, patient- and family-centered care for patients with various types of pmd.

Eligibility criteria:
sample 1: patients with former pmd inclusion criteria: 1. pmd within the past 24 months before the interview, 2. recovered from acute pmd and stable for at least 12 months before the interview; 3. able to share experiences; 4. more than 18 years old 5. speak and understand german 6. at least 1 diagnosis in the last perinatal phase out of 4 groups of psychiatric disorders (icd-10 chapter v, f00-f99): 1. mood (affective) disorders (f30-f39); anxiety disorders (f41); reaction to severe stress, and adjustment disorders (f43); and obsessive-compulsive disorder (f42); 2. disorders of adult personality and behavior (f60-f69; especially f60.3 emotionally unstable personality disorder); 3. mental and behavioral disorders due to psychoactive substance use (f10-f19; excluding tobacco (f17) if it is the sole f-diagnosis of the patient); 4. psychosis (f20-f29 schizophrenia, schizotypal and delusional disorders). exclusion criterion: current pregnancy sample 2: professional health and social care providers inclusion criteria: 1. professional experience of at least two years, 2. have cared for at least 2 pmd patients the year before the focus group, a 3. speak and understand german.

Keywords: social stigma access to care facilitators barriers